İbrahim DUVAN, Süleyman SÜRER, Ayşegül Melike ŞENKAL, İlker İNCE, Uğursay KIZILTEPE

Endovascular solution in a complex post-dissectional thoracic aortic aneurysm case

A 45-year-old male patient presented to our clinic with a post-dissectional thoracic aortic aneurysm with the retrograde filling of the false lumen. He previously underwent a Bentall operation and a proximal thoracic endovascular aortic repair. We carried out a bare metal stent implantation concomitant with endograft extension and stent-assisted balloon-induced intimal disruption and relamination procedure consecutively. Although true lumen expansion was achieved, the aneurysmatic dilation of the descending thoracic aorta was kept on expanding due to perfusion of the false lumen by the distal re-entries. Therefore, it was decided to perform a totally false lumen thrombosis by the candy-plug technique. In conclusion, despite being a fatal disease, endovascular treatment of post-dissectional thoracic aortic aneurysm post-dissectional thoracic aortic aneurysm is possible in anatomically suitable patients with a stepwise approach in experienced endovascular centers.

Kompleks bir diseksiyon sonrası torasik aort anevrizma olgusunda endovasküler çözüm

Diseksiyon sonrasında yalancı lümeninin retrograd doluşu ile torasik aort anevrizması olan 45 yaşında bir erkek hasta kliniğimize başvurdu. Hasta daha önce Benthal ameliyatı ve proksimal torasik endovasküler aort onarımı geçirmişti. Hastaya sırasıyla, çıplak metal stent implantasyonu ile birlikte endogreft uzatma ve stentle desteklenen, balon indüksiyonu ile intimada yırtık oluşturulan alanda reappozisyon uygulandı. Gerçek lümenin genişlemesinin sağlanmasına rağmen, distal re-entryler aracılığıyla yalancı lümen perfüzyonunun devam etmesi nedeniyle, inen torasik aortun anevrizmatik dilatasyonunun ilerlediği görüldü. Bu nedenle, candy-plug tekniği ile yalancı lümenin tamamen tromboze olmasının sağlanmasına karar verildi. Sonuç olarak, ölümcül bir hastalık olmasına rağmen, diseksiyon sonrası torasik aort anevrizmanın anatomik olarak uygun olan hastalarda, deneyimli merkezlerde, aşamalı yaklaşımlarla endovasküler yöntemler uygulanarak tedavisi mümkündür.

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